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How well do vital signs identify children with serious infections in paediatric emergency care?

M Thompson1, N Coad, A Harnden

  • 1Department of Primary Health Care, Oxford University, Oxford, UK. matthew.thompson@dphpc.ox.ac.uk

Archives of Disease in Childhood
|July 18, 2009
PubMed

Insights

Vital signs effectively identify serious infections in children, showing comparable diagnostic accuracy to the Manchester Triage Score and NICE traffic light system. This simple approach aids in differentiating serious pediatric infections.

Area of Science:

  • Pediatric Emergency Medicine
  • Infectious Disease Diagnostics
  • Clinical Triage Systems

Background:

  • Accurate identification of serious infections in children is crucial for timely intervention.
  • Existing triage systems like the Manchester Triage Score (MTS) and NICE traffic light system are used but may be complex.
  • The diagnostic utility of basic vital signs in identifying serious pediatric infections requires further evaluation.

Purpose of the Study:

  • To assess if vital signs can identify children with serious infections.
  • To compare the diagnostic value of vital signs against the MTS and NICE traffic light system.

Main Methods:

  • Prospective cohort study of 700 children presenting with suspected acute infection at a UK teaching hospital.
  • Data collected included vital signs, level of consciousness, activity, respiratory distress, hydration, and MTS category.
  • Infection severity was categorized as serious, intermediate, minor, or not infected.

Main Results:

  • Children with serious or intermediate infections were more likely to present with fever (≥39°C), tachycardia, low oxygen saturation (≤94%), or prolonged capillary refill time (CRT >2 seconds).
  • A combination of fever, low saturation, tachycardia, and tachypnea demonstrated 80% sensitivity and 39% specificity for serious/intermediate infections.
  • This performance was comparable to the MTS (84% sensitivity, 38% specificity) and NICE system (85% sensitivity, 29% specificity).

Conclusions:

  • A combination of vital signs can effectively differentiate children with serious infections in a pediatric assessment setting.
  • Vital signs offer comparable sensitivity to more complex triage systems for identifying serious pediatric infections.
  • Further research is needed to validate combined vital signs and the NICE system in lower-prevalence populations.
Abstract

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